In 2007, approximately 9 million older adults and younger people with disabilities were simultaneously covered by both Medicare and some level of Medicaid--a population commonly known as dual eligibles or duals. Dual eligibles are the poorest, sickest, and costliest of all Medicaid beneficiaries--representing 15 percent of Medicaid enrollees and 39 percent of the program's spending in 2007--with the majority of the costs going to pay for long-term services and supports not covered by Medicare. Duals are also costly to Medicare, accounting for 16 percent of the program's enrollees and more than one-quarter (27 percent) of program spending in 2006. Because of their vulnerable health status and their costs to both programs, there is considerable interest in exploring ways to deliver high-quality, coordinated services to this population, in an effort both to improve their care and rein in costs. With the federal government administering Medicare and each state administering its own Medicaid program, the delivery of health care services for duals can be fragmented and confusing. Several programs seek to address this fragmentation by offering various types and levels of care coordination for dual eligibles. In addition, the federal government is funding demonstration projects aimed at identifying new, high-quality strategies for delivering care to the dual eligible population. Missing from the discourse are the voices of dual eligibles themselves. Changes to the way their care is organized and delivered could have profound effects on their health, quality of life, and satisfaction. To address this void, the AARP Public Policy Institute (PPI) sponsored this focus group study of dual eligibles to learn more about their experiences of care across several care models. Between February and August 2011, ten focus groups were conducted in five cities with duals and, in some cases, their family members. We examined duals who were receiving care through the following models: fee-for-service Medicare and Medicaid; enhanced Primary Care Case Management (PCCM); partially integrated Medicare Special Needs plans (SNP); fully integrated Medicare Special Needs Plans; and the Program of All-Inclusive Care for the Elderly (PACE). All participants within each focus group were from the same delivery model.
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